Provider Demographics
NPI:1811410905
Name:BERMAN, RIVKI (MS RDN)
Entity Type:Individual
Prefix:
First Name:RIVKI
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MS RDN
Other - Prefix:
Other - First Name:CHAYA
Other - Middle Name:
Other - Last Name:BERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:38-55 DAURIA DR
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-5104
Mailing Address - Country:US
Mailing Address - Phone:845-304-3043
Mailing Address - Fax:
Practice Address - Street 1:4-14 SADDLE RIVER RD STE 203
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5624
Practice Address - Country:US
Practice Address - Phone:201-815-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86017332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty